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Arthroplasty

(1) Surgical reconstruction or replacement of a malformed or degenerated joint
arthrodesis - the surgical fixation of a joint which is intended to result in bone fusion

(2) Arthroplasty is the field of medicine dealing with the surgical reconstruction and total replacement of degenerated joints. Arthroplasty requires the use of prosthetics; thus key factors such as biomechanics, prosthetic design, metallurgy and biomaterials are taken into account for surgical procedures.

Various materials such as glass, cobaltchromium alloy and Teflon have been experimented with in order to create biocompatible joint replacements. Researchers have also worked to find the most effective methods of securing the implant to the bone. The common types of arthroplastic procedures include total hip replacement and total knee prosthesis, and since 2004 artificial disc replacement to replace a spinal disc has been approved and in use in the US.

Definition

Arthroplasty is surgery performed to relieve pain, or prevent further disease of, and restore range of motion by realigning or reconstructing a dysfunctional joint.

Purpose

The goal of arthroplasty is to restore the function of a stiffened synovial joint and relieve pain. As a surgical procedure, it is usually performed when medical treatment has not improved function in the affected joint. There are two types of arthroplastic surgery: joint resection and interpositional reconstruction. Joint resection involves removing a portion of the bone from a stiffened joint, increasing the space between the bone and the socket to improve the range of motion. Scar tissue eventually fills the gap, narrowing joint space again. Pain is relieved and motion is restored, but the joint is less stable.

Interpositional reconstruction is surgery to reshape the joint and add a prosthetic disk between the two bones forming the joint. The prosthesis can be made of plastic, metal, ceramic material, or formed from such body tissue as skin, muscle, or fascia. When interpositional reconstruction fails, total joint replacement may be necessary. Joint replacement is also called total joint arthroplasty.

Preparation

Prior to arthroplasty, all the standard preoperative blood and urine tests are performed. The patient meets with the anesthesiologist to discuss any special conditions that affect the administration of anesthesia.

Aftercare

Patients who have undergone arthroplasty must be careful not to over stress or destabilize the joint. Physical therapy is begun immediately. Antibiotics are given to prevent infection.

Risks

Joint resection and interpositional reconstruction do not always produce successful results, especially in patients with rheumatoid arthritis. Repeat surgery or total joint replacement may be necessary. As with any major surgery, there is always a risk of an allergic reaction to anesthesia or that blood clots will break loose and obstruct the arteries.

Normal results

Most patients recover with improved range of motion in the joint and relief from pain.

Excision arthroplasty

One that involves removal of some component of the joint, e.g. femoral head or patella.